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General NPI Number Information
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NPI Number | 1336620236
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Entity Type | Individual
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Provider Name | DESIREA SCOTT-MOORE DDS
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Gender | Female
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Dates
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Enumeration Date | 08/28/2018
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Last Update Date | 12/22/2020
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Provider Practice Location Address
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Address Line | 2310 E HARMONY RD STE 103
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City | FORT COLLINS
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State | CO
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Zip | 80528-3427
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Country | US
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Telephone | 970-282-8877
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Fax |
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Provider Business Mailing Address
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Address Line | 2310 E HARMONY RD STE 103
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City | FORT COLLINS
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State | CO
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Zip | 80528-3427
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DEN.00203818
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 30025553
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License Number State | OH
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